A face-lift (rhytidectomy) is a cosmetic surgical procedure to create a younger appearance in your face. The procedure can reduce the sagging or folds of skin on the cheeks and jawline and other changes in the shape of your face that occur with age.
During a face-lift, a flap of skin on each side of the face is pulled back, and tissues below the skin are surgically altered to return the contour of the face to a more youthful shape. Before the flap is sutured closed, excess skin is removed.
A neck lift (platysmaplasty) is often done as part of a face-lift to reduce fat deposits and sagging skin on the neck.
A face-lift won't decrease fine creases or wrinkles in your skin or damage from sun exposure. Other cosmetic procedures can address the appearance or quality of the skin itself.
Why it's done
As you get older, the appearance and shape of your face is altered because of normal age-related changes. Your skin becomes less elastic and looser, and fat deposits decrease in some areas of your face and increase in others. Age-related changes in your face that may be reduced with a face-lift include the following:
- Sagging appearance of your cheeks
- Excess skin at your lower jawline (jowls)
- Deepening of the fold of skin from the side of your nose to the corner of your mouth
- Sagging skin and excess fat in the neck (if the procedure includes a neck lift)
A face-lift isn't a treatment for superficial wrinkles, sun damage, creases around the nose and upper lip, or irregularities in skin color.
A face-lift can give your face and neck a more youthful appearance. Face-lift results are not permanent. With age, the facial skin may begin to droop again. In general, a face-lift can be expected to last 10 years.
How you prepare
Medical history and exam. Prepare to answer questions about past and current medical conditions, previous surgeries, previous plastic surgeries, complications from previous surgeries, history of smoking, and drug or alcohol use. Your surgeon will do a physical exam, may request recent records from your doctor or order a consultation with a specialist if there are any concerns about your ability to undergo surgery.
Medication review. Provide the name and dosages of all medications you regularly take, including prescription drugs, over-the-counter drugs, herbal medications, vitamins and other dietary supplements.
Facial exam. Your plastic surgeon will take photos of your face from different angles and close-up photos of some features. The surgeon will also examine your bone structure, shape of your face, fat distribution and quality of your skin to determine your best options for face-lift surgery.
Expectations. Your surgeon will ask questions about your expectations for the outcomes of a face-lift. He or she will help you understand how a face-lift will likely change your appearance and what a face-lift doesn't address, such as fine wrinkles or naturally occurring asymmetry in your face.
Before a face-lift:
Follow medication directions. You'll receive instructions about what medications to stop taking and when to stop. For example, you'll likely be asked to discontinue any blood-thinning medication or supplement at least two weeks before surgery. Talk to your doctor about what medications are safe to take or whether the dosage should be adjusted.
Wash your face and hair. You'll likely be asked to wash your hair and face with a germicidal soap the morning of the surgery.
Avoid eating. You'll be asked to avoid eating anything after midnight the night before your face-lift. You will be able to drink water and take medications that have been approved by your surgeon.
Arrange for help during recovery. If your face-lift is done as an outpatient procedure, make plans for someone to drive you home after surgery and stay with you the first night after surgery.
A face-lift surgery can cause complications. Some can be managed with appropriate care, medication or surgical correction. Long-term or permanent complications, while rare, can cause significant changes in appearance. The risks include:
- Hematoma. A collection of blood (hematoma) under the skin that causes swelling and pressure is the most common complication of face-lift surgery. Hematoma formation, which usually occurs with 24 hours of surgery, is treated promptly with surgery to prevent damage to skin and other tissues.
- Scarring. Incision scars from a face-lift are permanent but typically concealed by the hairline and natural contours of the face and ear. Rarely, incisions can result in raised, red scars. Injections of a corticosteroid medication or other treatments might be used to improve the appearance of scars.
- Nerve injury. Injury to nerves, while rare, can temporarily or permanently affect nerves that control sensation or muscles. Temporary paralysis of a select muscle, resulting in an uneven facial appearance or expression, or temporary loss of sensation can last a few months to a year. Surgical interventions may offer some improvement.
- Hair loss. You might experience temporary or permanent hair loss near the incision sites. Permanent hair loss can be addressed with surgery to transplant skin with hair follicles.
- Skin loss. Rarely, a face-lift can interrupt the blood supply to your facial tissues. This can result in skin loss (sloughing). Sloughing is treated with medications, appropriate wound care and, if necessary, a procedure to minimize scarring.
Like any other type of major surgery, a face-lift poses a risk of bleeding, infection and an adverse reaction to anesthesia. Certain medical conditions or lifestyle habits also can increase your risk of complications. The following factors may present a significant risk or result in unfavorable results, and your doctor may advise against a face-lift.
- Blood-thinning medications or supplements. Medications or supplements that thin the blood can affect your blood's ability to clot and increase the risk of hematomas after surgery. These medications include blood thinners (Coumadin, Plavix, others), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), ginseng, Ginkgo biloba, fish oil and others.
- Medical conditions. If you have a medical condition that prevents blood clotting, you won't be able to have a face-lift. Other conditions, such as poorly controlled diabetes or high blood pressure, increase the risk of poor wound healing, hematomas and heart complications.
- Smoking. Smoking significantly increases the risk of poor wound healing, hematomas and skin loss after a face-lift.
- Weight fluctuation. If you have a history of repeated weight gain and loss — factors that affect the shape of your face and condition of your skin — the outcome of the surgery may not be satisfactory or may be satisfactory for only a short time.
During the surgery
A face-lift can be done in a hospital or an outpatient surgical facility. Sometimes the procedure is done with sedation and local anesthesia, which numbs only part of your body. In other cases, general anesthesia — which renders you unconscious — is recommended. In general, a face-lift involves elevating the skin and tightening the underlying tissues and muscles. Fat in the face and neck may be sculpted, removed or redistributed. Facial skin is then re-draped over the newly repositioned contours of the face, excess skin is removed, and the wound is stitched or taped closed.
The incisions for the procedure depend on the techniques that will be used and the patient's preferences. Options include:
- A traditional face-lift incision starts at your temples in the hairline, continues down and around the front of your ears and ends behind your ears in your lower scalp. An incision might be made under your chin to improve the appearance of your neck.
- A limited incision is a shorter incision that begins in your hairline just above your ear, wraps around the front of your ear, but does not extend all the way into the lower scalp.
- Neck lift incision starts in front of your earlobe and continues around your ear into your lower scalp. A small incision also is made under your chin.
A face-lift generally takes two to four hours but might take longer if other cosmetic procedures are done at the same time.
After the procedure
- After a face-lift, you may experience:
- Mild to moderate pain
- Drainage from the incisions
- Contact your doctor immediately if you have:
- Severe pain on one side of your face or neck within 24 hours of surgery
- Shortness of breath
- Chest pain
- Irregular heartbeats
- Your incisions will likely be covered with bandages that provide gentle pressure to minimize swelling and bruising. A small tube might be placed under the skin behind one or both of your ears to drain any excess blood or fluid.
- In the first few days after surgery:
- Rest with your head elevated
- Take pain medication as recommended by your doctor
- Apply cool packs to the face to ease pain and reduce swelling
Before - After
Frequently Asked Questions
What is the best age to have a facelift?
The best candidate for a facelift is usually a person in their fifties, but this can vary with each individual. A person with poor skin elasticity, sagging skin and a noticeable relaxation of the neck and jowl is a candidate for a facelift. If someone is bothered by their facial appearance, a consultation with a board certified plastic surgeon like Dr. Barış Çin could help them find a solution to their facial rejuvenation needs.
How is a traditional facelift different from a mini facelift?
The so called “mini facelift” is limited in scope when compared to a traditional facelift. In a “mini lift,” the skin and muscle dissections are less extensive, which is why the results they produce are usually not as long lasting as those obtained with a traditional facelift. This is why the best candidate for a mini lift is someone who has previously undergone a facelift and only needs restoration of that work.
How can I avoid getting a pulled-up look from a facelift?
Board certified plastic surgeons like Dr. Hernandez perform surgery with a keen awareness of the individual’s facial anatomy and underlying structures. A facelift from a qualified plastic surgeon will not result in a stretched or windblown look because the contouring is achieved by lifting and repositioning the underlying facial structures, not by stretching the skin. This is the marked difference between a board certified plastic surgeon and other “cosmetic doctors” who offer “quick” surgical solutions with minimal down time.
Are there non-surgical alternatives for a facelift?
Certain facial deficiencies such as loss of volume in the mid-face, cheeks and certain areas around the mouth where wrinkles are common can be addressed with fillers and injectables. In consultation with an experienced plastic surgeon like Dr. Barış Çin, you will be informed of all available facial procedures that may address your areas of concern. However, no treatment or procedure would be as complete and long lasting as a traditional face lift. This well-proven procedure requires lifting and removing excess skin while repositioning the muscles and anatomy underneath.
What other procedures can I combine with a facelift for a younger look?
Nowadays, fat grafting is commonly performed alongside a facelift to fill in the compartments of the face that may have been depleted of natural volume. Patients who look tired and deflated due to a loss of facial fat, collagen or hyaluronic acid can restore some of that natural youthful volume on their faces with fat grafting. Other procedures that Dr. Barış Çin commonly performs during a facelift are eyelid surgery, brow lifts, chin implants, lip lifting and laser resurfacing. Additionally, dermal fillers and injectables may be used after surgery for a finishing touch.
How much younger will I look, and how long does a facelift last?
Generally, facelifts in which the underlying muscle is properly repositioned last from eight to twelve years and make people look ten years younger on average. How patients care for themselves will determine the longevity of the procedure. Factors that can help sustain a youthful appearance after surgery are: protecting the skin from sun exposure, frequent use of moisturizers, and maintaining a healthy diet and stable weight.
How long is the recovery time?
Recovery time from a facelift usually takes between two and four weeks, depending on the individual’s needs and the extent of the procedure. Some patients can go back to work after two weeks, but if a patient has had a laser resurfacing treatment along with their facelift they would need a slightly longer recovery time. It is best to wait at least four weeks before resuming a full schedule of work and exercise.
How long should swelling and numbness last after a facelift?
Not everybody experiences numbness after a facelift but those who do might experience loss of sensation around the ears or the earlobe itself. This condition, which is temporary, may last from a few weeks to a few months. After surgery, there may be mild swelling that is visible for about two to four weeks. The internal swelling of the face may last longer but is not visible.
How can I avoid bruising after a facelift?
Some bruising and discoloration of the skin for the first two weeks after a facelift is normal. Patients who have a tendency to bruise, such as those taking aspirin, vitamin E, herbs, alcohol and blood thinners, may be more prone to noticeable bruising. It is important that patients discontinue all of these products for four weeks prior to surgery. To minimize bruising, Dr. Barış Çin recommends that patients take Bromaline and Arnica Montana, which aid in post-surgical healing.
How much pain will I have after facelift surgery?
Pain is not usually experienced after facelift surgery. Some may feel slight discomfort at the drain sites in the back of the ears and perhaps a sensation of tightness in the neck area. Most patients only need over-the-counter pain medications like Tylenol® to help with any discomfort they might experience. Prescription medications are provided in case they are needed.